Neoadjuvant chemoradiation therapy (NCRT) has been associated with a lower rate of local recurrence and represents an accepted standard of care. Yet, access to treatment or decisions about treatment can be affected by contextual factors such as rural residence (RD) and distance travel to cancer center (DTC). In the current study, we evaluated relationship between RD and DTC and NCRT.
A cohort of patients diagnosed with localized rectal cancer during 2009-2013 in the province of Saskatchewan was studied. The logistic regression analyses were performed to assess relationship between RD and DTC and lack of NCRT.
Total 279 patients were identified with median age of 66 yrs (IQR:59-76) and M:F of 1:0.71. 94 (33.6) had a major comorbid illness. 183 (65%) were rural resident. The median DTC was 141 km (IQR 7-233). Of 279 patients, 116 (41%) were referred for NCRT, 161 (58%) underwent upfront surgery, and 2 declined surgery. The mean DTC for group treated with NCRT was 111.5 ±122km compared with 169.0±176km if they did not receive NCRT (p = 0.001). Of urban resident, 52/96 (54%) were referred for NCRT compared with 64/183 (35%) of rural resident (p = 0.002). After excluding 33 (12%) patients who had clinical stage I disease and underwent upfront surgery, a univariate regression analysis revealed that both DTC (OR 1.92, 95% CI: 1.15-3.20) and RD (OR 2.51, 95%CI: 1.46-4.32) were significantly correlated with lack of NCRT. On multivariate analysis following relationships were noted with lack of NCRT. Age ≥ 70 yrs (OR 1.45, 95%CI: 0.84-2.45), comorbid illness (OR 1.52, 0.86-2.67), ECOG performance status of > 1 (OR 1.25, 0.49-3.17), DTC (OR 1.07, 0.51-2.23), and RD (OR 2.56, 1.17-5.57).
Our results revealed that RD but not DTC is associated with a lower rate of NCRT in patients with localized rectal cancer. Future studies are required to explore the underlying cause of differential referral.
Clinical trial identification
Legal entity responsible for the study
Saskatchewan Cancer Agency
All authors have declared no conflicts of interest.